The Thoracic Surgery Branch routinely handle referrals from the NCI Surgery Branch, Pediatric Oncology Branch, Endocrine Oncology Branch, Experimental Transplantation & Immunology Branch, as well as the National Heart, Lung, and Blood Institute, and National Institute of Allergy and Infectious Disease. Thoracic Surgery volumes during the past 15 years have ranged from 150-175 cases annually, which have been covered by only two thoracic surgeons. The vast majority of cases performed on the Thoracic Surgery Service are high index procedures in patients who have already had multiple surgeries and/or chemotherapeutic regimens, or are severely immunocompromised. These procedures include extrapleural pneumonectomies, radical pleurectomies, mediastinal exenterations with major vascular resections/reconstructions, chest wall resections, complex pulmonary resections and thoracoplasties for primary lung cancers, pulmonary metastases and multidrug resistant resistant mycobacterial or fungal infections, and esophagectomies. Approximately 50% of all cases performed in the Thoracic Surgery Branch are consult cases; additionally, there are approximately 200 consults annually that do not result in operations in the short term, such as management of pneumothoraces, indeterminant pulmonary nodules, and second opinions.